TN 12 (08-00)

A. Policy — Notifying State Medicaid Agency

Since 7/1/88 it has been a requirement to notify the State Medicaid Agency about resources transferred by individuals filing for or receiving SSI. This requirement applies both for initial claims and in posteligibility (e.g., redeterminations). This notification requirement was not changed by P.L. 106-169 (Foster Care Independence Act of 1999).

B. Procedure — Reporting to Medicaid

1. Initial claims and posteligibility

If the individual alleges a transfer, send a report containing the information below to the appropriate State Medicaid agency indicating that this is a transfer case.

2. When to send the information

Send the information to the States on a flow basis, but not less than once per month. Negative reports are not necessary. Do not maintain copies of the report once transfer information has been sent to the State Medicaid agency.

NOTE: It is not necessary to notify the State Medicaid agency about a transfer if the SSI claim is denied.

3. Where to send information

• In States where SSA makes the Medicaid eligibility determination pursuant to a section 1634 agreement (SI 01715.020), send the transfer information to the same address used for assignment of rights (AOR) and third-party-liability (TPL) information. (See regional instructions or contact your regional office for correct addresses.)

• In States where SSA does not have an agreement to make Medicaid eligibility decisions for the States, see regional instructions for the correct address to send the information.

4. Preparing the report

a. Initial claims

• For initial claims processed on MSSICS, send a copy of the Property/Cash Given or Sold (RGIV) page and any associated remarks to the State Medicaid agency.

• For initial claims processed on paper forms, send a photocopy of the transfer of resource information recorded on the SSA-8000-BK.

b. Posteligibility

• For posteligibility transfers processed on MSSICS, send a copy of the Property/Cash Given or Sold (RGIV) page and any associated remarks.

• For posteligibility transfers processed outside of MSSICS, prepare a written report on any suitable form (e.g., an SSA-5002) with the information in SI 01150.012B.5.

5. Information required for medicaid notification

The report to the State Medicaid agency should include the individual's name, address, SSN, application date and the following transfer information:

• date of transfer;

• description of resource transferred;

• current market value of the resource transferred;

• compensation received or expected;

• recipient or purchaser of resource;

• relationship of purchaser or recipient to former owner; and

• co-owners at the time of transfer, if any.

C. Reference

Medicaid, SI 01715.020